Effect of strontium ranelate on serum leptin and bone turnover markers in women with established postmenopausal osteoporosis.

OBJECTIVE: To assess the association between leptin levels and bone mineral density (BMD) and bone metabolism markers in postmenopausal women taking strontium ranelate. STUDY DESIGN: In this longitudinal uncontrolled study, postmenopausal osteoporotic women were administered strontium ranelate and categorized into 1 of 2 groups: overweight and lean. BMD, serum leptin, bone-specific alkaline phosphatase (ALP) and urinary deoxypyridinoline (Dpd) were assessed at baseline, 6 and 12 months of the therapy. RESULTS: For all 47 women, leptin levels increased at the sixth month (p = 0.001) and 1 year after treatment (p = 0.001), Dpd levels decreased at the sixth month (p = 0.001) and 1 year after treatment (p = 0.003), but ALP levels did not change with respect to basal levels. Spine and hip BMD also increased at the end of 1 year (p = 0.01 and p = 0.001, respectively). For overweight women leptin levels increased 6 months and 1 year after treatment (p = 0.003 and p = 0.001, respectively). Dpd levels decreased significantly at the sixth month and at 1 year (p = 0.001 and p = 0.041), but ALP levels did not change. Hip and spine BMD also increased (p = 0.036 and p = 0.002). The lean group had similar serum results and BMD scores after treatment. CONCLUSION: Our data supports a positive effect of leptin on bone metabolism in favor of bone resorption inhibition in postmenopausal osteoporotic women on strontium treatment.

A reliable way to predict intraabdominal adhesions at repeat cesarean delivery: scar characteristics.

OBJECTIVE: To evaluate association between scar characteristics and intraabdominal adhesions at repeat cesarean delivery. DESIGN: A prospective, cross-sectional study. SETTING: Tertiary Government Maternity Training Hospital in Ankara, Turkey. POPULATION: 295 pregnant women with at least one prior cesarean delivery. METHODS: All women were at least 36 weeks pregnant. Appearance of previous cesarean delivery scars was categorized into three groups - flat, depressed and elevated. Pigmentation status was also noted (non-pigmented or pigmented). MAIN OUTCOME MEASURES: Intraoperatively detected adhesions, evaluated and classified into three groups (no adhesion, filmy adhesion and dense adhesion groups) by a modified Nair's classification. RESULTS: Elevated scars had significantly more dense adhesion formation than depressed ones (31.4 vs. 12.7%, p=0.02). No difference was found for dense adhesions when depressed and flat scars were compared (12.7 vs. 6.8%, p=0.124). Of flat scars, 93.2% were free of dense adhesions. Pigmented scars had more dense adhesions than non-pigmented (26.6 vs. 9.3%, p<0.01). Using logistic regression analysis scar length, scar width and appearance of scar (flat or non-flat) were directly related to adhesion formation. CONCLUSION: There is an association between scar type and adhesions, particularly for hypertrophic scars and dense adhesions.

Debulking surgery for incompletely operated advanced epithelial ovarian carcinoma.

BACKGROUND AND OBJECTIVES: There is still no any data about the role of re-operation and re-debulking in previously incompletely operated advanced staged patients with epithelial ovarian carcinoma (EOC). In this study, the authors aimed to analyze the effect of an incomplete primary surgery on patient prognosis. METHODS: Clinicopathological variables of 317 advanced staged EOC patients were retrospectively collected. RESULTS: Twenty-nine patients had an initial incomplete surgery and referred to our center for debulking while remaining 288 had undergone primary debulking surgery at our institution. Comparison of the two groups with respect to clinicopathological variables could not reveal significant difference. Median survival was 3.24 years for re-operated patients while it was 2.07 years for patients who had undergone primary debulking surgery. Upon multivariate analysis, final optimal debulking, tumor grade and a history of an incomplete surgery before the final debulking were the significant prognosticators. A subgroup analysis of re-staged patients could not reveal a significant role for either the type or the time interval between the operations. CONCLUSION: A history of an incomplete primary surgery does not seem to adversely affect patient prognosis and the optimal cytoreductive success achieved in final debulking surgery is still the most important prognostic factor.

Use of hyaluronic acid for vaginal stenosis in a woman with a history of imperforate hymen and transverse vaginal septum: a case report.

BACKGROUND: Female reproductive tract abnormalities are common and may occur in various combinations. Management usually involves surgery. However, therapeutic failures may be experienced and repeated surgical interventions may be required. CASE: A 26-year-old woman who was subjected to surgery for imperforate hymen coexistent with transverse vaginal septum 10 years previously presented with hypomenorrhea and severe dysmenorrhea. Vaginal stenosis at the level of partially excised transverse septum was detected. The patient was successfully managed with complete surgical excision of transverse vaginal septum with application of hyaluronic acid to prevent restenosis. CONCLUSION: Women presenting with a reproductive tract abnormality should be evaluated carefully to detect the presence of combined abnormalities and to avoid the need for additional interventions. Also, further studies are needed to warrant the use of adhesion-preventing agents as an adjunct to surgical procedures to avoid therapeutic failures.